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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

LAKE MINNETONKA DENTAL CENTER PLLC
NPI 1215590575
Dentist in Wayzata, MN

Active since April 22, 2019
109 BUSHAWAY RD STE 300, WAYZATA, MN 55391(952) 475-0225 Get Directions Write a Review

NPPES record last updated: July 21, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 21, 2026, Apr 22, 2019 (2 updates tracked since 2019).

About Lake Minnetonka Dental Center Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE MINNETONKA DENTAL CENTER PLLC (NPI 1215590575) is a healthcare organization registered as a dentist in Wayzata, Minnesota and active in the NPI registry since April 2019. The organization lists Victoria Johnson, Cro, as its authorized official.

NPPES Registry Identity

NPI1215590575
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameLAKE MINNETONKA DENTAL CENTER PLLC
Location Address109 BUSHAWAY RD STE 300Wayzata, MN 55391-2079
Mailing Address109 Bushaway Rd Ste 300Wayzata, MN 55391-2079
Phone(952) 475-0225
Organization SubpartNo
Authorized OfficialVictoria JohnsonCro · (941) 444-0558
Enumeration DateApril 22, 2019
Last NPPES UpdateJuly 21, 20262 updates tracked since enumeration
NPPES CertifiedJuly 21, 2026
✔ NPI 1215590575 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
109 BUSHAWAY RD STE 300, Wayzata, MN 55391
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CYNTHIA PERONE DDS
Dentist
109 BUSHAWAY RD STE 300
WAYZATA, MN 55391
Hennepin County (952) 212-0168
BRYAN NEIL LASKIN D.D.S.
Dentist (General Practice)
109 BUSHAWAY RD STE 300
WAYZATA, MN 55391
Hennepin County (952) 475-0225

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Minnetonka Dental Center PLLC's NPI number?

The NPI number for Lake Minnetonka Dental Center PLLC is 1215590575. It was assigned to this organization in the NPPES registry on April 22, 2019.

Where is Lake Minnetonka Dental Center PLLC located?

Lake Minnetonka Dental Center PLLC is located at 109 Bushaway Rd Ste 300, Wayzata, MN 55391. The listed phone number is (952) 475-0225.

What is Lake Minnetonka Dental Center PLLC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for Lake Minnetonka Dental Center PLLC was last updated on July 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 31 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.